Current treatment options for secondary hyperparathyroidism in patients with stage 3 to 4 chronic kidney disease and vitamin D deficiency. Issue 11 (2nd November 2021)

• Record Type: Journal Article
• Authors: Galassi, Andrea; Ciceri, Paola; Porata, Giulia; Iatrino, Rossella; Boni Brivio, Giulia; Fasulo, Eliana; Magagnoli, Lorenza; Stucchi, Andrea; Frittoli, Michela; Cara, Anila; Cozzolino, Mario
• Is Part Of: Expert opinion on drug safety. Volume 20:Issue 11(2021)
• Page Start: 1333
• Page End: 1349
• Publication Date: 2021-11-02
• Subjects: Secondary hyperparathyroidism -- 25(Oh)D -- cholecalciferol -- calcifediol -- VDRA -- CKD -- nutritional therapy; Drugs -- Side effects -- Periodicals; Drugs -- Toxicology -- Periodicals; Chemotherapy -- Periodicals; 615.704
• DOI: 10.1080/14740338.2021.1931117
• Languages: English
• ISSNs: 1474-0338

Abstract

ABSTRACT: Introduction: Secondary hyperparathyroidism (SHPT) represents a complication of chronic kidney disease (CKD). Vitamin D system is altered since early CKD, and vitamin D deficiency is an established trigger of SHPT. Although untreated SHPT may degenerate into tertiary hyperparathyroidism with detrimental consequences in advanced CKD, best treatments for counteracting SHPT from stage 3 CKD are still debated. Enthusiasm on prescription of vitamin D receptor activators (VDRA) in non-dialysis renal patients, has been mitigated by the risk of low bone turnover and positive calcium-phosphate balance. Nutritional vitamin D is now suggested as first-line therapy to treat SHPT with low 25(OH)D insufficiency. However, no high-grade evidence supports the best choice between ergocalciferol, cholecalciferol, and calcifediol (in its immediate or extended-release formulation). Areas covered: The review discusses available data on safety and efficacy of nutritional vitamin D, VDRA and nutritional therapy in replenishing 25(OH)D deficiency and counteracting SHPT in non-dialysis CKD patients. Expert opinion: Best treatment for low 25(OH)D and SHPT remains unknown, due to incomplete understanding of the best homeostatic, as mutable, adaptation of mineral metabolism to CKD progression. Nutritional vitamin D and nutritional therapy appear safest interventions, whenever contextualized with single-patient characteristics. VDRA should be restricted to uncontrolled SHPT by first-line therapy.